Prediction of difficulties in laparoscopic cholecystectomy on the base of routinely available parameters in a smaller regional hospital.

BACKGROUND: Identification of preoperative factors that indicate difficulties in the operation are in the function of primary prevention of intraoperative complications and require selection of an experienced surgical team, planning of operating program and timely provision of information to patients about the increased likelihood of conversion. AIM: Identification of preoperative factors of operative difficulties by analysis of routine clinical parameters. PATIENTS AND METHODS: A prospective cohort study of patients who underwent laparoscopic cholecystectomy from February 2005 to December 2009. All patients were operated by the same surgeon. There were 369 operated patients. Conversion was done in 10 patients. Main outcome measures were: duration of stages of laparoscopic cholecystectomy and conversion; identification of predictive parameters; assessment of their predictive value; assessment of the predictive value of individual parameters in respect to the duration of stages of laparoscopic cholecystectomy; correlation of parameter predictive value and duration of laparoscopic cholecystectomy stage. RESULTS: Multivariate stepwise linear regression analysis showed that previous history of acute cholecystitis, gallbladder wall thickness ˃ 4 mm, acute cholecystitis to admission, size of calculus > 2 cm, > 5 attacks of pain that lasted longer of 4 hours, diabetes mellitus, duration of symptoms longer then 36 months and pericholecystic fluid collection were significant for prediction of difficulties of laparoscopic cholecystectomy. CONCLUSIONS: Based on clinical, laboratory and ultrasonographic parameters without the use of highly sophisticated diagnostic procedures and increasing medical costs it is possible to predict difficulties in the laparoscopic cholecystectomy.

[Quality of life in patients with surgical treatment of hip fractures, preliminary study].

INTRODUCTION: Fractures of the proximal segment of the femur occurring most commonly in elderly patients are a serious, both medical (orthopaedic) and socioeconomic, problem. MATERIAL AND METHODS: 46 patients (14 male and 32 female) operated for hip fracture in the January-June 2008 period, who were available for analysis (as 24 patients were not) were investigated. In addition to descriptive analysis, general health status-quality of life was assessed by means of SF-36 questionnaire comprising eight groups of questions determining the physical, psychological and social status of the patients within the 0 to 100 (problem) points range. RESULTS: The findings were that the average patient age was 74 years (76.9 for male patients and 74.06 fro female ones). The values of all eight parameters were lower by up to 89% in comparison to the pre-injury values, but improved by as much as 50% after six months (for physical functioning and the role of physical functioning) or by 30% for the role of emotions. The values never return to their pre-injury levels. In foreign studies, the parameters are higher, especially post-treatment values for vitality and role of emotions. CONCLUSION: In patients treated for hip fractures, it is necessary to carry out an assessment of general, physical, mental and social functioning of the patient in addition to the assessment of their clinical and radiological findings, so as to get a more realistic insight in the status of the treated and operated patients. The SF-36 questionnaire is widely used in such investigations along with other questionnaires. It is also necessary to investigate the general health status-quality of life of the entire healthy population in our country.

Quality of life in patients with multiple sclerosis in Serbia.

OBJECTIVES: The aim of this investigation was to evaluate factors that might influence the health-related quality of life (HRQoL) in multiple sclerosis (MS) patients in Serbia. MATERIALS AND METHODS: This cross-sectional study was performed on a group of 156 patients with MS. HRQoL was assessed by using the SF-36 questionnaire. Expanded Disability Status Scale (EDSS) and Beck Depression Inventory (BDI) scale were assessed as variables affecting the HRQoL of MS patients. RESULTS: EDSS score correlated negatively with all SF-36 health dimensions, and the highest statistically significant coefficients were for physical functioning (r = -0.682), and social and role functioning (r = -0.407 and -0.405 respectively). BDI correlated statistically significantly negatively (P < 0.01) with all SF-36 health dimensions. CONCLUSIONS: Our findings suggest that both disability and depression significantly influence the HRQoL in Serbian MS patients, with depressive symptoms having the major influence.

Blood pressure levels in 7 to 14-year-old Belgrade children.

The objective of the work was to study blood pressure and some anthropometric characteristics in children. The study design included the prevalence study at Belgrade, Serbia and Montenegro. The study comprised 1651 subjects (809 boys and 842 girls) aged 7-14 years, that is, 2.6% of all relevant population. The average levels of systolic and diastolic blood pressures (SBP and DBP) were 113.4/70.3 mmHg in boys and 114.6/71.1 mmHg in girls. High SBP was present in 4.7% of boys and in 5.3% of girls. High DBP was found in 5.6% of boys and in 4.8% of girls. According to multivariate regression analysis, in boys SBP and DBP were significantly associated with age, body mass index (BMI) and subscapular skinfold, SBP was also associated with body weight, and DBP with triceps skinfold. In girls, SBP was significantly related to BMI, suprailiac skinfold and body height, and DBP was significantly associated with BMI, suprailiac and subscapular skinfolds. The results of the present study support the opinion that BMI is a significant predictor of blood pressure in children and point out to suprailiac skinfold in girls as a possible predictor of blood pressure.

Family history and risk of type 1 diabetes mellitus.

The aim of the study was to evaluate association of type 1 diabetes in children and adolescents with positive family history of type 1 diabetes, type 2 diabetes, and thyroid, adrenal, rheumatic, allergic, celiac and some other diseases. A case-control study was conducted in Belgrade. The case group comprised 105 subjects < or = 16 years old who were for the first time hospitalized because of type 1 diabetes during the period 1994-1997. For each case, two controls were chosen among children and adolescents treated for skin diseases. Cases and controls were individually matched by age (+/- one year), sex and place of residence (all were from Belgrade). In the statistical analyses we used chi(2)-test, Fisher's exact test and univariate and multivariate logistic regressions. According to multivariate logistic regression analysis, risk of type 1 diabetes was significantly associated with a positive family history for type 1 diabetes (OR = 4.04; 95% CI, 2.31-7.07), allergic diseases (OR = 3.32; 95% CI, 1.63-6.76), celiac and Crohn's diseases (OR = 11.02; 95% CI, 1.14-106.89) and other diseases (thrombocytopenia, alopecia areata, psoriasis, chronic uveitis and pernicious anemia; OR = 3.63; 95% CI, 1.05-12.48).

Smoking as risk factor for cervical cancer.

In a matched case-control study which comprised 33 cases with cervical carcinoma in situ, 67 cases with invasive cervical cancer, and 100 hospital controls, ever-smoking was found to be significantly related to cervical cancer (Odds ratio = 5.9, 95% confidence interval = 1.2-29.3) after adjustment for a variety of confounding variables.

Risk factors for basal cell carcinoma.

The aim of this study was to assess the risk factors for basal cell carcinoma (BCC). A case-control study, carried out in two towns in Yugoslavia, comprised 200 BCC cases and 399 controls. For statistical analysis, univariate and multivariate logistic regressions were used. The risk factors found for BCC were: freckling before the age 15, seven or more weeks per year spent at the seaside during holidays (lifetime average), outdoor work during summer-time, occupational exposure to organic and non-organic dissolvents and organophosphatic compounds, use of tar for cosmetic purposes, and previous BCC in personal history. Subjects who tended to burn and not to tan after sun exposure also showed a significantly higher risk for BCC. Brown eyes and history of acne had a protective effect. This study confirmed the role of both constitutional and environmental factors in the development of BCC.

[Trends in mortality in Serbia, excluding the provinces, 1973-1994]. / Trend mortaliteta u Srbiji bez pokrajina, 1973-1994. godine.

The war and break up of former Yugoslavia began in 1991. In May 1992 the United Nations imposed economic sanctions on Serbia and Montenegro which were suspended only in November 1995. The purpose of this study was to assess the effects of the war and UN sanctions on health of the population of Serbia without the provinces of Vojvodina and Kosovo. The period 1973-1994 was studied. Mortality data were derived from unpublished and published materials of the Federal Institute of Statistics [1]. Refugees, who, because of civil war, came to Serbia and Montenegro from other parts of former Yugoslavia, were not counted as a part of the population when mortality rates were calculated. Mortality rates were standardized directly using the "European population" as the standard [2]. The least square method was used to fit mortality rates to different trend curves. Linear trend was used whenever it significantly (p < 0.05) demonstrated the existing mortality rates. To measure the possible effect of the war and sanctions (WAS) on mortality between 1991 and 1994, dummy variable (variable WAS) consisting of 0's and 1's was made to signify the passage from the period before and the period after the beginning of the war and sanctions [3]. Over the period 1991-1994, characterized by the war and UN sanctions, in women aged 25-34, 35-44 and 75-84, total mortality was significantly higher than expected on the basis of the trend for the preceding period (p = 0.006, p = 0.000 and p = 0.015 respectively). The opposite effect was found in the age group 85+ (p = 0.012)/Table 2. Of major causes of death, in age group 25-34, mortality from endocrine diseases increased more rapidly in both sexes (p = 0.000) and mortality from urogenital diseases in women decreased more slowly than expected (p = 0.006). On the other hand, in age group 85+ mortality was significantly lower for cardiovascular diseases in both sexes (p = 0.035 and p = 0.006), for respiratory diseases in men (p = 0.011) and for neoplasms in women (p = 0.006)/Table 4. In addition, in the years 1991 and 1992 the increase in mortality from injuries and poisoning was evident in men aged 15-24, 25-34 and 85+ years (Graph 5). Our results show that over the period 1991-1994 changes in mortality were present in some age groups and were caused by certain groups of diseases. In men, besides mortality of infectious disease which decreased more slowly during 1991-1993 than expected, [4], the main departures were found in the mortality from injuries and poisoning and in mortality from endocrine diseases. The excess of death due to injuries and poisoning in the age group 15-34 can be explained as a direct consequence of the war. There were no military operations on the territory of Serbia, but young men from Serbia were nevertheless engaged in the war in other republics of former Yugoslavia. The outstanding increase in mortality caused by injuries and poisoning in men aged 85+ has two explanations. The first is the fact that suicide rate which was on an average of 86 per 100,000 over the period 1984-1990 rose to 140 per 100,000 during the period 1991-1993. In the year 1994 it fell to 92 per 100,000. Since there were no great differences in percent distribution of suicides among all deaths caused by injuries and poisoning in the two periods (27% in 1984-1990 and 20% in 1991-1993), it is clear that the rise of suicidal rate cannot be the only explanation for increased mortality from injuries and poisoning. In a situation when medical services were badly overextended (lack of medical equipment and proper maintenance of the existing equipment, lack of drugs and other medical inputs, a large number of wounded coming from Bosnia as well as numerous refugees) [5, 6], priority had to be given to younger age groups. Higher mortality due to endocrine diseases in men and women aged 25-34 years and higher mortality due to urogenital diseases in women of the same ages can be most probably attributed to poor medical supplies. Although formally excluded from the international economic blockade medical supplies were in practice badly affected by the fact that the dinar was rendered almost worthless and the Ministry of Health could no longer pay the medical inputs. In addition, bureaucratic hurdles of getting clearance from the UN added months of delay and made foreign companies unwilling to trade [5, 7]. The supply and distribution of drugs within the country was also irregular because communication lines were cut and local companies were not prepared to risk distributing drugs that nobody could pay for [7]. Higher than expected mortality in women aged 25-44 over the period 1991-1994 could be probably explained by their higher vulnerability (period of fertility) and the fact that the main burden of family survival was on them, so they had no time to think and to take care of their health. (ABSTRACT TRUNCATED)

The survey of healthcare software in Yugoslavia.

The aim of this study is to identify vendors of software packages applicable to health care system as well as to evaluate software packages offered to the health sector by a variety of sources, namely state owned software development companies, privately operated software development companies as well as sole traders. The approach undertaken was to preselect the potential suppliers via an initial targeted interview. Subsequently a questionnaire, consisting of 23 questions, was addressed to the selected vendors and suppliers. The response rate to the questionnaire was 58%. Investigation of 113 has revealed the non government software suppliers clearly lead in copyright ownership, IBM compatible personal computers were the platform of choice whereas majority of code was written utilising languages capable of supporting relational data base queries. The final outcome of the above study is a database of software packages and applications available to the health sector offering the health professionals and institutions guide lines and support in developing information systems, relevant subsystems and modules.

Personal identifying number as a unique patient identifier in database on clinically treated patients in Belgrade: its use, advantages and drawbacks.

Database on clinically treated patients in Belgrade served as an example for analysis of possibilities for the use of Personal Identifying Number (PIN) as an Unique Patient Identifier. In the first part of the paper we analyzed filling up of the fields which contained data on PIN within complete databases in 1981, 1991 and 1996. Filling up of PIN was significantly changed in the three observed years: it was 18% in 1981; 68% in 1991, and 56% in 1996 respectively. Analysis of interactions among the chosen factors (type of hospital, demographic and social characteristics of patients, length of stay in hospital, manner of treatment, main diagnosis, treatment outcome) and measuring time, showed a different degree of statistical significance. In the second part of our paper we analyzed the unexpected decrease in filling up of PIN in 1996 (as compared to 1991) ussing the method of logistic regression, on 1% samples from the databases for the two respective years. On the basis of obtained models of filling up of UPI data, taken as dependent variable and the above factors (predictors) we analyzed the advantages and drawbacks of UPI application as an unique patient identifier.

Cepstral distance measures of hormone concentration time series.

In this paper we present a class of time series distance measures based on the difference of their cepstral transformations. We emphasise the convenience of the proposed distance measure in the cases when the time series can be treated as output of a linear system driven with a quasi-periodic stochastic signals. In order to illustrate the cepstral time series distance measure we applied them in cluster and multidimensional scaling analysis of daily hormonal secretion fluctuation series taken from a group of patients before and after surgery.

[The effect of cigarette smoking during pregnancy on fetal growth]. / Uticaj pusenja cigareta u trudnoci na rast ploda.

The association between maternal smoking and poor pregnancy outcome, which is well established in medical literature, has been confirmed during the study conducted in one of Belgrade hospitals. The study comprised 1011 women who gave birth to a live born baby between June 1992 and March 1993 (infants with malformations were excluded). The women were interviewed by one person during the first three days after delivery. Data were collected on smoking habits during the first, second and third trimester of pregnancy, and on potential confounders including age, education, marital status, obstetric history, height, weight before pregnancy, weight gain during pregnancy, history about diseases before and during pregnancy, housekeeping and occupational activities, data about delivery and data about alcohol consumption. By the use of factor analysis infants characteristics, taken from medical histories, were classified in two groups: I group-birth weight, birth length, head circumference and chest circumference; II group-apgar score after one and after five minutes. The rough relation of smoking to the outcome was examined first. Adjustment was made for the potential confounders by the use of multiple regression analysis. Variables associated with both smoking and birth weight or apgar score after one minute (i.e. maternal height and weight) were considered as potential confounders. Infant sex, gestational age and parity were also included as possible confounders due to their strong link with birth weight and apgar. In the sample 42% of women were smokers, and 98% of them smoked filter cigarettes. In the group of smokers 312 smoked throughout pregnancy and 111 were inconsistent smokers (those who smoked during one or two trimesters only). According to smoking habits, mothers were divided into three groups: nonsmokers, those who smoked 1-9 cigarettes per day and those who smoked 10 or more cigarettes per day (Table 1). There was a strong relationship with significant linear trend between smoking and all observed birth outcomes except apgar score (Table 2). Significant reductions in birth weight (by 205 g), birth length (by 1.28 cm), head circumference (by 0.38 cm) and chest circumference (by 0.66 cm) were found to be associated with an average daily smoking of 10 or more cigarettes after adjustment was made for potential confounders. Even a smaller number of cigarettes affected foetal growth. Infants born by mothers who throughout pregnancy smoked 1-9 cigarettes per day (mean 4.07, range 1-8) weighted significantly less (by 89 g) and had head circumference significantly smaller (by 0.23 cm) in comparison with infants born by mothers nonsmokers. Inconsistent smoking during pregnancy had no significant effect on foetal growth with the exception of smaller birth length (by 2.30 cm; p = 0.002) in infants born by mothers who smoked during the second and third trimester. It is possible that the relatively small number of women inconsistent smokers had a bearing on the results. According to the results obtained it seems that either there is no threshold for the effect of smoking on foetal growth, or it is very low. Nevertheless, since the effect of smoking is weaker if the number of cigarettes smoked is smaller it is reasonable to assume that the reduction in the number of cigarettes smoked in pregnancy would serve as prevention irrespective whether the threshold existed or not.

Infectious diseases mortality in central Serbia.

STUDY OBJECTIVE: To determine the influence and the effect of the war in the former Yugoslavia and of the United Nations economic sanctions on mortality from infectious diseases. DESIGN: This was a descriptive study analysing mortality data time series. SETTING: Central Serbia, Yugoslavia. PARTICIPANTS: The population of central Serbia was the subject of the study (about six million inhabitants). MEASUREMENTS: Mortality rates were standardised directly, using the "European population" as the standard. Regression analysis and analysis of covariance were undertaken. MAIN RESULTS: During the period 1973-93, mortality from infectious diseases showed a decreasing trend. From 1987-90, and infectious diseases was significantly higher than expected on the basis of the trend for the preceding period (p = 0.020 and p = 0.00). In addition, there was a statistically significant departure from the preceding trend (p = 0.036) in men between 1991 and 1993 (the period of the war and UN sanctions)--the main effect being in younger age groups. CONCLUSION: The economic crisis in the former Yugoslavia during the 1980s followed by the outbreak of the war and the damaging effects of UN economic sanctions had a distinctly adverse effect on mortality from infectious diseases.

Diet and prostate cancer: a case-control study.

A case-control study, performed in two towns of Serbia (Yugoslavia) from 1990 to 1994, comprised 101 patients with histologically confirmed prostate cancer and 202 hospital controls individually matched by age (+/-2 years), hospital admittance and place of residence. Dietary information was obtained by using a standard questionnaire. After adjustment for possible confounders, risk factors for prostate cancer appeared to be the highest tertile of protein (odds ratio (OR) = 13.54, 95% confidence interval (CI) = 2.38-77.13), saturated fatty acid (OR = 3.63, 95% CI = 1.03-12.79), fibre (OR = 4.02, 95% CI = 1.38-11.73), and vitamin B12 intake (OR = 2.07, 95% CI = 1.08-3.97); a protective effect was found for the highest tertile of alpha-tocopherol (OR = 0.15, 95% CI = 0.05-0.53), calcium (OR = 0.37, 95% CI = 0.14-0.99) and iron intake (OR = 0.34, 95% CI = 0.12-0.95). There were significant (P < 0.05) linear trends in the odds ratios for alpha-tocopherol, vitamin B12, calcium and iron. According to logistic regression step by step analysis, risk factors for prostate cancer were dietary intake of retinol equivalent (OR = 1.64, 95% CI = 1.01-2.67) and vitamin B12 (OR = 1.87, 95% CI = 1.15-3.05), and a protective effect was found for dietary intake of iron (OR = 0.40, 95% CI = 0.27-0.58).

Developing mortality patterns: robust modified generalized likelihood ratio algorithm for infant mortality rate change detection.

A new robust modified generalized likelihood ratio algorithm, which enables the changes of mortality rates to be detected automatically, is applied. The procedure is based on the calculation of discrimination function using robust least squares estimates of AR mortality rates residuals. The feasibility of the approach is demonstrated with experimental data concerning infant mortality rate in Serbia.

[Implementation of health informatics: system of the medical educational informatics]. / Generisanje informacionog sistema u zdravstvu: informacioni sistem medicinske edukacije--organizacija prijemnog ispita.

Topics of this report concerns the existing elements of informatics related to education of graduate students of the Medical Faculty in Belgrade. The already used practice of this system makes possible effectiveness and quality in this work. System itself contains quite a few data bases: for students, for teaching stuff and their associates, general juridic features, curricula as defined according to respective mode. In this academic year 1993/94 this system undergoes the exploitation step while, for the first time, has been used in the admission of students. Using this respective model results (particularly those of the testing in Chemistry and Biology as well as in some crucial questions therein) were analysed related to admission testing and numerous other competitor's characteristics, including success in previous studying and many other socio-demografic data. Improvement of such an approach reflects in feedback information derived from precedent educational institutions, and in possibility of the prompt reaction in case of any remark attributed to the actual studying. It is also capable of meeting primary requirements in every educational process for the rational analysis about minor failure and/or positive elements in education.

[Glossary of medical informatics terminology]. / Mali recnik informatike u medicini i zdravstvu.

This paper presents the most frequently used terms in the field of informatics and computer applications in medicine and health care. Out of over 4,000 terms that are frequently used in computer science and allied fields, we have chosen only 108. The criteria has been their usage in this Supplement and better understanding of the presented papers. Each term has its Serbian translation, original English term and short explanation. At the end of the paper is an English - Serbian register and a survey of computer's and informatic's glossaries.

[Methods of study of the effects of modern administration (management) on the autonomy and satisfaction of physicians in clinical practice]. / Metod ispitivanja uticaja savremonog upravljanja (menadzment) na autonomiju i satisfaktsiju lekara u klinickom radu.

Marketing principles in health care delivery systems, reducing financial funds for health institutions and permanently increasing costs of medical equipment are responsible for the growing influence of management on physician's autonomy and working satisfaction. A questionnaire research was carried out in order to determine the best method of examination of this influence in Belgrade. All tested persons were medical doctors working in a primary health centers for 7 hours per day, who examined about 26 patients every day. More than a half of physician improved their knowledge by reading professional publications 6 hours per week. In spite of the fact that they all worked in the same institution, they expressed different opinions regarding the organisation. In the physicians' opinion clinical freedom and working satisfaction were at the high level, and partly connected with management practice. At the same time they were very unsatisfactory with personal income and budgetary distribution in the institution. It is evident that the method described in this article is useful in the analysis of the present situation related to management and physician's practice in the country.